Bryan颈椎人工椎间盘置换术后10年随访结果

Cervical arthroplasty with Bryan disc: 10-year follow-up results

中文关键词:  颈椎病  人工椎间盘置换术  长期随访  异位骨化  二次手术

英文关键词:Cervical spondylosis  Cervical disc arthroplasty  Long-term follow-up  Heterotopic ossification  Reoperation

中文摘要:

  【摘要】 目的：观察Bryan颈椎人工椎间盘置换术后10年随访结果和并发症。方法：纳入在我院骨科行Bryan颈椎人工椎间盘置换术且获得长期随访、临床和影像学资料均完整的60例患者，其中神经根型颈椎病15例，脊髓型颈椎病41例，混合型颈椎病（脊髓型+神经根型）4例。47例患者为单节段置换，12例为双节段置换，1例为3节段置换。随访时间为124.0±8.3个月（117~150个月）。采用mJOA评分和VAS评分分别评估脊髓型颈椎病和神经根型颈椎病临床疗效，分析二次手术的原因和二次手术方案；颈椎屈伸位X线片评估末次随访时节段活动度情况，采用McAfee异位骨化分级观察末次随访时异位骨化情况。结果：脊髓型颈椎病患者术前mJOA评分为13.4±2.2分，末次随访时为15.8±1.1分（P＜0.05）。神经根型颈椎病患者术前上肢VAS评分为5.7±2.2分，末次随访时为0.7±0.9分（P＜0.05）；术前颈痛VAS评分为4.7±2.2分，末次随访时为1.0±1.0分（P＜0.05）。混合型颈椎病患者术前mJOA评分为13.3±3.6分，末次随访时为15.4±1.1分；术前上肢VAS评分为4.3±2.6分，末次随访时为1.0±1.4分；术前颈痛VAS评分为2.8±1.5分，末次随访时为2.5±1.9分。7例患者接受了二次手术治疗，其中6例为手术节段异位骨化（包括初次手术单节段椎间盘置换术5例，双节段置换术1例；二次手术时3个节段异位骨化分级为Ⅲ级，4个节段为Ⅳ级）导致的新症状而行手术节段二次手术，1例为邻椎病行后路单开门椎管扩大成形术。74个手术节段的术前活动度为7.0°±2.9°，末次随访时活动度为4.6°±4.1°（P＜0.05）。末次随访时74个手术节段中有53个节段出现异位骨化，根据McAfee异位骨化分级，其中5个节段为Ⅱ级，21个节段为Ⅲ级，27个节段为Ⅳ级。结论：Bryan颈椎人工椎间盘置换术后随访10年取得了较好的疗效，但异位骨化的发生率较高，降低了手术节段的活动度，严重的异位骨化会导致手术节段出现新的神经症状而被迫行二次手术。

英文摘要:

  【Abstract】 Objectives: To evaluate the radiographic and clinical outcomes of Bryan cervical disc arthroplasty at 10 years follow-up. Methods: Sixty patients with complete clinical and radiographic data were included in this study. The mean follow-up period was 124.0±8.3 months(117-150 months). 47 patients underwent single-level arthroplasty and 12 underwent arthroplasty at two levels. 1 patient underwent arthroplasty at three levels. 15 of the 60 patients presented with radiculopathy and 41 patients with myelopathy, 4 patients were with combined radiculopathy and myelopathy. Clinical evaluations included mJOA score, VAS score, etiology and surgical strategy of reoperations. Radiographic evaluations included heterotopic ossification according to McAfee′s classification and the range of motion on dynamic X-rays at baseline and at final follow-up. Results: The mJOA score of the patients with myelopathy was 13.4±2.2 at baseline and 15.8±1.1(P＜0.05) at final follow-up. The arm VAS score of the patients with radiculopathy was 5.7±2.2 at baseline and 0.7±0.9(P＜0.05) at final follow-up. The neck VAS score of the patients with radiculopathy was 4.7±2.2 at baseline and 1.0±1.0(P＜0.05) at final follow-up. The mJOA score of the patients with combined radiculopathy and myelopathy was 13.3±3.6 at baseline and 15.4±1.1 at final follow-up. The arm VAS score was 4.3±2.6 at baseline and 1.0±1.4 at final follow-up. The VAS neck score was 2.8±1.5 at baseline and 2.5±1.9 at final follow-up. 1 patient received reoperation due to adjacent segment disease. 6 patients received revision surgeries at the index level for recurrent radiculopathy or myelopathy caused by heterotopic ossification (The initial surgeries included 1 cases of arthroplasty at two levels and 5 case of single-level arthroplasty; 3 levels were classified as grade Ⅲ heterotopic ossification and 4 levels as grade Ⅳ before the reoperations). On X-ray examination, the range of motion at the operated level was 7.0°±2.9° at baseline and 4.6°±4.1° at final follow-up(P＜0.05). Heterotopic ossification was observed in 53(71.6%) levels. According to McAfee′s classification, 5 levels were classified as grade Ⅱ, 21 levels were classified as grade Ⅲ and 27 levels as grade Ⅳ. Conclusions: Cervical arthroplasty with Bryan cervical disc prosthesis resulted in fine clinical outcomes at long-term follow-up. The rate of heterotopic ossification was high after Bryan disc arthroplasty and heterotopic ossification accounted for most of the reoperations.